High antibiotic resistance of <i>Helicobacter pylori</i> and its effect on tailored and empiric eradication of the organism in Lower Silesia, Poland

Ferenc, Stanisław; Gnus, Jan; Kościelna, Magdalena; Kinda, Małgorzata; Yarka, Andriy; Stewart, Luke A.; Witkiewicz, Wojciech

doi:10.1111/hel.12365

Cited by 21 publications

(22 citation statements)

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“…Resistance rates of metronidazole in both adult and children populations were relatively high – 32.8% and 25%, respectively. Metronidazole resistance remains high across Europe with no major changes in 10 years or regional distribution ().…”

Section: Discussionmentioning

confidence: 99%

Primary antibiotic resistance of Helicobacter pylori strains among adults and children in a tertiary referral centre in Lithuania

Dargienė

Kupčinskas

Jonaitis

et al. 2017

APMIS

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The study evaluated primary antibiotic resistance of Helicobacter pylori within the period 2013-2015 and trends of antibiotic consumption over the last decade in Lithuania; 242 adults and 55 children were included in the study. E-tests were performed for amoxicillin, metronidazole, clarithromycin, ciprofloxacin, rifampicin and tetracycline. The presence of H. pylori and clarithromycin resistance was additionally tested by PCR. Helicobacter pylori culture was positive in 67 of 242 (28%) adult and in 12 of 55 (21.8%) children samples. Resistance rates among adults by E-tests were as follows: metronidazole -32.8% (95% confidence interval (CI): 22.7-44.7%), ciprofloxacin -7.5% (95% CI: 3.2-16.3%), rifampicin -7.5% (95% CI: 3.2-16.3%), amoxicillin -0%, whereas resistance rates in children were as follows: metronidazole -25% (95% CI: 8.9-53.2%), rifampicin -8.3% (CI: 1.5-35.4%), amoxicillin and ciprofloxacin -0%. Accumulated clarithromycin resistance rates by E-tests and PCR were 8.2% (95% CI: 4.1-16.0%) in adults and 17.7% (95% CI: 6.2-41.0%) in children. Total use of macrolides and lincosamides in Lithuania increased from 1.26 to 1.86 defined daily dose (DDD)/1000 inhabitants/day among adults, while it has doubled from 1.10 to 2.22 DDD/1000/children/day in children within 2003-2015. There are no significant changes in the susceptibility of H. pylori to the most widely used antibiotics in adults over the last years in Lithuania; however, clarithromycin resistance among children exceeds 15% and mandates further larger-scale studies in paediatric population.

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Section: Discussionmentioning

confidence: 99%

Primary antibiotic resistance of Helicobacter pylori strains among adults and children in a tertiary referral centre in Lithuania

Dargienė

Kupčinskas

Jonaitis

et al. 2017

APMIS

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“…4,5 However, the H. pylori resistance rates to antibiotics have increased in most areas of the world, suggesting that fewer antibiotics will be available to eradicate H. pylori over time. [7][8][9] Consequently, antibiotic susceptibility testing is important for H. pylori eradication. [7][8][9] Consequently, antibiotic susceptibility testing is important for H. pylori eradication.…”

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confidence: 99%

A systematic review and meta‐analysis of genotypic methods for detecting antibiotic resistance in Helicobacter pylori

Wang

et al. 2018

Helicobacter

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“…A significant and welcome increase was noted over the last year in the number of studies addressing the important topic of antimicrobial resistance in H. pylori infection. These are summarized in Table . A key message emerging is the relentless rise in antibiotic resistance, especially to clarithromycin and levofloxacin.…”

Section: Antimicrobial Resistancementioning

confidence: 99%

“…A study from Poland looked at tailoring initial triple therapy based on AST to amoxicillin, clarithromycin, levofloxacin, and metronidazole and found that, when such a strategy was employed, eradication rates were significantly better (95.5% vs 86.6%) . This strategy has previously been used predominantly for third‐line or “rescue” therapies.…”

Section: Antimicrobial Resistancementioning

confidence: 99%

“…84 A study from Poland looked at tailoring initial triple therapy based on AST to amoxicillin, clarithromycin, levofloxacin, and metronidazole and found that, when such a strategy was employed, eradication rates were significantly better (95.5% vs 86.6%). 77 This strategy has previously been used predominantly for third-line or "rescue" therapies. A meta-analysis on this topic was conducted this year which concluded that cure rates, using susceptibility-guided treatment, were 72% and that the evidence in favor of such a rescue therapy is currently insufficient to recommend its use.…”

Section: Antimicrobial Resistancementioning

confidence: 99%

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Treatment of Helicobacter pylori infection 2017

et al. 2017

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Over the last decade, it has been widely reported that the success of Helicobacter pylori eradication treatment is falling. A steady decline was observed in the number of patients achieving eradication with standard first-line triple therapy of two antibiotics and a proton pump inhibitor [1][2][3]. It now appears that the first-line eradication therapies most commonly used in everyday clinical practice fall considerably short of the 80% intention-to-treat (ITT) eradication rates that are considered the minimal acceptable levels as recommended in the Maastricht guidelines [4]. Interestingly, two studies emerged from Asian centers in the last 12 months, which show that, in this part of the world at least, eradication levels using standard therapies remain close to 80%. A Malaysian study showed a standard 1-week pantoprazole, amoxycillin, and clarithromycin regimen to be well tolerated and highly efficacious with a per-protocol eradication rate of 84% [5]. A Japanese study showed remarkably consistent per-protocol eradication rates from 2001 to 2009 fluctuating between 75 and 78% for standard 7-day triple-therapy regimens [6]. A limit of many studies especially those including clarithromycin or levofloxacin is that H. pylori susceptibility to the drugs, which is the main prediction of failure, was not tested. LevofloxacinThe use of levofloxacin as a first-line therapy has been examined in great depth in the last year. Levofloxacin may be used as a substitute for clarithromycin in either a standard triple or sequential regimen. A large study comparing the antibiotics in either regimen shows a clear advantage to levofloxacin in both combinations. Per-protocol cure rates for triple therapy were 66% for omeprazole-clarithromycin-amoxycillin compared with 83% for omeprazole-levofloxacin-amoxycillin and 81% for omeprazole-amoxycillin-clarithromycin-metronidazole vs 85% for omeprazole-amoxycillin-levofloxacinmetronidazole, with no difference in compliance rates or adverse events [7]. It has been proposed that sequential levofloxacin-based regimens are of most benefit in areas where clarithromycin resistance is in excess of 15%, and another study in such an area showed eradication rates of 81% with clarithromycin sequential therapy compared with 96% with levofloxacin sequential therapy. A third arm in this study looked at the dose of levofloxacin required and illustrated no benefit in increasing the dose from 250 to 500 mg [8]. Indeed, another study went so far as to suggest that once-daily dosing of a levofloxacin-based triple regimen may be as efficacious as twice daily [9]. The literature from Asia also seems to support levofloxacin as a good alternative first-line therapy. A study on a triple regimen showed per-protocol eradication rates of 78% for standard clarithromycin-containing therapies compared with 83% for a levofloxacin-based regimen [10]. Another study from the Middle East looked at whether combining clarithromycin and levofloxacin in the same regimen could be Keywords Peptic ulcer disease, resistance, compli...

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High antibiotic resistance of Helicobacter pylori and its effect on tailored and empiric eradication of the organism in Lower Silesia, Poland

Abstract: Antibiotic resistance is notably high in Poland currently, but both tailored and empiric therapies can achieve acceptable cure rates equal to or higher than 90%.

Cited by 21 publications

References 40 publications

Primary antibiotic resistance of Helicobacter pylori strains among adults and children in a tertiary referral centre in Lithuania

Primary antibiotic resistance of Helicobacter pylori strains among adults and children in a tertiary referral centre in Lithuania

A systematic review and meta‐analysis of genotypic methods for detecting antibiotic resistance in Helicobacter pylori

Treatment of Helicobacter pylori infection 2017

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